When staffing legislation was introduced, New Jersey nurse leaders recognized from the research and their years of clinical leadership experience that the work environment is a multidimensional concept and that staffing is not the only variable related to nurse and patient outcomes. Thus, an understanding of what nurses need in their hospital environment to practice nursing effectively was sought.The aim of this study was to examine the evidence regarding clinical nurses' perception of what they need to practice nursing effectively in the acute care hospital environment.The following population, intervention, comparison, outcome question was used to search the literature databases PubMed, CINAHL, Johanna Briggs, and the Sigma Theta Tau Henderson Library: In the hospital environment what do nurses perceive as needed to practice nursing effectively? Specific search criteria and the Johns Hopkins nursing guidelines and tools were used to identify relative studies.The final review, which addressed what nurses in the hospital environment need to practice nursing effectively, included 25 articles: 20 were an evidence level III, and five were evidence level II. From this review, five key concepts were identified: Leadership, autonomy/decision making, respect/teamwork, resources/staffing, and organizational commitment to nursing.This integrative review, which explored nurses' perceptions of what is needed to provide effective quality care, identified that providing quality care is multifactorial in nature. Resources, including but not limited to staffing, and leadership were identified as important by nurses as a key factor in supporting quality care. Nurses must be provided with resources and infrastructure to do their jobs, in an environment supported by authentic transformational leadership.